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Effect of Virtual Monoenergetic Images From Spectral Detector Computed Tomography on Coronary Calcium Blooming. J Comput Assist Tomogr 2018; 42:912-918. [DOI: 10.1097/rct.0000000000000811] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Stehli J, Clerc OF, Fuchs TA, Possner M, Gräni C, Benz DC, Buechel RR, Kaufmann PA. Impact of monochromatic coronary computed tomography angiography from single-source dual-energy CT on coronary stenosis quantification. J Cardiovasc Comput Tomogr 2016; 10:135-40. [DOI: 10.1016/j.jcct.2015.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022]
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Shmilovich H, Cheng VY, Dey D, Rajani R, Nakazato R, Otaki Y, Nakanishi R, Vashistha V, Min JK, Berman DS. Optimizing image contrast display improves quantitative stenosis measurement in heavily calcified coronary arterial segments on coronary CT angiography: A proof-of-concept and comparison to quantitative invasive coronary angiography. Acad Radiol 2014; 21:797-804. [PMID: 24809320 DOI: 10.1016/j.acra.2014.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/23/2014] [Accepted: 02/25/2014] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES Blooming artifact from calcified plaques often renders measurement of stenosis impossible on coronary computed tomographic angiography (CTA). We sought to evaluate the impact of modifying window level on reducing blooming artifact, and its impact on stenosis quantification. MATERIALS AND METHODS We analyzed 125 calcified segments from 53 patients who underwent CTA and invasive coronary angiography (ICA). Segmental stenosis on CTA was measured using three window settings: width of 1000 Hounsfield units (HU) and level of 200 HU ("default"), 1500/200 HU ("widened"), and width and level based on the mean HU of the calcified plaque and pericoronary fat ("calcium-specific"). Segmental stenosis on ICA was quantified by a blinded experienced reader. RESULTS ICA found ≥50% stenosis in 30 segments. Displaying segments with widened and calcium-specific settings improved overall accuracy of detecting ≥50% stenosis (P's < 0.001) by increasing the rate of accurately quantifying <50% stenosis (P's < 0.001), and improved correlation of stenosis quantification to ICA (P's < 0.05). There was no difference in stenosis quantification accuracy between widened and calcium-specific window settings. Limits of agreement between CTA stenosis quantification and ICA narrowed with widened and calcium-specific settings. CONCLUSIONS We showed for the first time that in calcified segments, widening display window width significantly improved CTA quantification of stenosis compared to ICA.
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Affiliation(s)
- Haim Shmilovich
- Department of Medicine and Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building No. 1258, Los Angeles, CA 90048.
| | - Victor Y Cheng
- Department of Medicine and Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building No. 1258, Los Angeles, CA 90048
| | - Damini Dey
- Department of Medicine and Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building No. 1258, Los Angeles, CA 90048
| | - Ronak Rajani
- Department of Medicine and Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building No. 1258, Los Angeles, CA 90048
| | - Ryo Nakazato
- Department of Medicine and Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building No. 1258, Los Angeles, CA 90048
| | - Yuka Otaki
- Department of Medicine and Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building No. 1258, Los Angeles, CA 90048
| | - Rine Nakanishi
- Department of Medicine and Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building No. 1258, Los Angeles, CA 90048
| | | | - James K Min
- Department of Medicine and Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building No. 1258, Los Angeles, CA 90048
| | - Daniel S Berman
- Department of Medicine and Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building No. 1258, Los Angeles, CA 90048
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Weininger M, Renker M, Rowe GW, Abro JA, Costello P, Schoepf UJ. Integrative computed tomographic imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2014; 9:27-43. [DOI: 10.1586/erc.10.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Danad I, Raijmakers PG, Knaapen P. Diagnosing coronary artery disease with hybrid PET/CT: it takes two to tango. J Nucl Cardiol 2013; 20:874-90. [PMID: 23842709 DOI: 10.1007/s12350-013-9753-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The noninvasive diagnosis of coronary artery disease (CAD) is a challenging task. Although a large armamentarium of imaging modalities is available to evaluate the functional consequences of the extent and severity of CAD, cardiac perfusion positron emission tomography (PET) is considered the gold standard for this purpose. Alternatively, noninvasive anatomical imaging of coronary atherosclerosis with coronary computed tomography angiography (CCTA) has recently been successfully implemented in clinical practice. Although each of these diagnostic approaches has its own merits and caveats, functional and morphological imaging techniques provide fundamentally different insights into the disease process and should be considered to be complementary rather than overlapping. Hybrid imaging with PET/CT offers the possibility to evaluate both aspects nearly simultaneously, and studies have demonstrated that such a comprehensive assessment results in superior diagnostic accuracy, better prognostication, and helps in guiding clinical patient management. The aim of this review is to discuss the value of stand-alone CCTA and PET in CAD, and to summarize the available data on the surplus value of hybrid PET/CT including its strengths and limitations.
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Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Fuchs TA, Stehli J, Fiechter M, Dougoud S, Gebhard C, Ghadri JR, Husmann L, Gaemperli O, Kaufmann PA. First experience with monochromatic coronary computed tomography angiography from a 64-slice CT scanner with Gemstone Spectral Imaging (GSI). J Cardiovasc Comput Tomogr 2013; 7:25-31. [PMID: 23452997 DOI: 10.1016/j.jcct.2013.01.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 09/21/2012] [Accepted: 01/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND New technology combining dual-energy CT with the latest gemstone detectors for spectral imaging (GSI) can be used to synthesize monochromatic images that mimic images as if different monochromatic x-ray sources were used. OBJECTIVE The aim of the study was to evaluate the optimal combination of monochromatic image energy and adaptive statistical iterative reconstruction (ASiR) for monochromatic reconstruction of coronary CT angiography (CTA) images with the use of GSI. METHODS Twenty consecutive patients underwent coronary CTA on a GSI capable 64-slice CT scanner (Discovery CT 750 High Definition, GE Healthcare). In 7 sets of monochromatic images (60, 65, 70, 75, 80, 90, and 110 keV; each with increasing contributions of ASiR, ie, 0%, 20%, 40%, 60%, and 80%; n = 35 reconstructions per patient), signal-to-noise (aortic root) and contrast-to-noise (left main artery) ratios were assessed. Signal-to-noise ratio, contrast-to-noise ratio, and image quality (graded on a 5-point Likert scale) were assessed in all above monochromatic reconstructions and compared with the respective standard (conventional polychromatic) image. RESULTS Compared with conventional polychromatic images, reconstructions with 60 keV and 80% ASiR showed the highest improvement in contrast-to-noise (144%; P < 0.001) and signal-to-noise ratio (173%; P < 0.001). Image quality reached a plateau at 65-75 keV with 40%-60% ASiR blending, yielding a maximal image quality score improvement of 50% compared with conventional imaging (P < 0.001). CONCLUSION In coronary CTA with low radiation technique (mean radiation dose, 1.8 ± 0.7 mSv), GSI with monochromatic reconstructions (65-75 keV) and ASiR (40%-60%) offers significant noise reduction and image quality improvement.
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Affiliation(s)
- Tobias A Fuchs
- Department of Radiology, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, CH-8091 Zurich, Switzerland
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Morsbach F, Berger N, Desbiolles L, Poropat T, Leschka S, Alkadhi H, Stolzmann P. Systematic analysis on the relationship between luminal enhancement, convolution kernel, plaque density, and luminal diameter of coronary artery stenosis: a CT phantom study. Int J Cardiovasc Imaging 2013; 29:1129-35. [PMID: 23329389 DOI: 10.1007/s10554-012-0173-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 12/21/2012] [Indexed: 11/29/2022]
Abstract
To systematically investigate into the relationships between luminal enhancement, convolution kernel, plaque density, and stenosis severity in coronary computed tomography (CT) angiography. A coronary phantom including 63 stenoses (stenosis severity, 10-90%; plaque densities, -100 to 1,000 HU) was loaded with increasing solutions of contrast material (luminal enhancement, 0-700 HU) and scanned in an anthropomorphic chest. CT data was acquired with prospective triggering using 64-section dual-source CT; reconstructions were performed with soft-tissue (B26f) and sharp convolution kernels (B46f). Two blinded and independent readers quantitatively assessed luminal diameter and CT number of plaque using electronic calipers. Measurement bias between phantom dimensions and CT measurements were calculated. Multivariate linear regression models identified predictors of bias. Inter- and intra-reader agreements of luminal diameter and CT number measurements were excellent (ICCs > 0.91, p < 0.01, each). Measurement bias of luminal diameter and plaque density was significantly (p < 0.01, each) lower (-12% and 58 HU, respectively) with B46f as opposed to B26f, especially in plaque densities >200 HU. Measurement bias was significantly (p < 0.01, each) correlated (ρ = 0.37-55 and ρ = -0.70-85) with the differences between luminal enhancement and plaque density. In multivariate models, bias of luminal diameter assessment with CT was correlated with plaque density (β = 0.09, p < 0.05). Convolution kernel (β = -0.29 and -0.38), stenosis severity (β = -0.45 and -0.38), and luminal enhancement (β = -0.11 and -0.29) represented independent (p < 0.05,each) predictors of measurement bias of luminal diameter and plaque number, respectively. Significant independent relationships exist between luminal enhancement, convolution kernel, plaque density, and luminal diameter, which have to be taken into account when performing, evaluating, and interpreting coronary CT angiography.
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Affiliation(s)
- Fabian Morsbach
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland
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Krupiński M, Miszalski-Jamka T, Guzik B, Andres M, Zmudka K, Mazur W, Pelberg R, Banyś R, Urbańczyk M, Kostkiewicz M. Computed tomography coronary angiography and invasive coronary angiography demonstrate high correlation for area stenosis quantification in noncalcified and mixed plaques. Clin Imaging 2012; 36:724-31. [PMID: 23154001 DOI: 10.1016/j.clinimag.2012.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 01/22/2012] [Accepted: 02/08/2012] [Indexed: 10/28/2022]
Abstract
We compared the variance of area and diameter significant stenosis measurement between quantitative computed tomography coronary angiography (QCTA) and quantitative invasive coronary angiography (QCA). Fifty patients presenting 65 significant coronary artery stenoses (≥70% area stenosis) in QCTA and QCA were included. Spearman's rank correlation revealed that area stenosis measurement by QCTA and QCA yields higher correlation than diameter stenosis and is highest for noncalcified and mixed lesions.
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Affiliation(s)
- Maciej Krupiński
- Center for Diagnosis, Prevention and Telemedicine, John Paul II Hospital, Kraków, Poland.
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A systematic approach for analysis, interpretation, and reporting of coronary CTA studies. Insights Imaging 2012; 3:215-28. [PMID: 22696084 PMCID: PMC3369123 DOI: 10.1007/s13244-012-0167-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 01/31/2012] [Accepted: 03/19/2012] [Indexed: 11/11/2022] Open
Abstract
Over the past years, the number of coronary computed tomography angiography (CTA) studies performed worldwide has been steadily increasing. Performing a coronary CTA study with appropriate protocols tailored to the individual patient and clinical question is mandatory to obtain an image quality that is diagnostic for the study purpose. This process can be considered the primary mainstay of each coronary CTA study. The secondary mainstay is represented by the correct analysis and interpretation of the acquired data, as well as reporting of the pertinent imaging findings to the referring physician. The latter process requires knowledge of the advantages and disadvantages of various post-processing methods. In addition, a standardized approach can be helpful to avoid false-positive and false-negative findings regarding the presence or absence of coronary artery disease. By implementing various radiation dose reduction techniques, care needs to be taken to keep the radiation dose of coronary CTA as low as reasonably achievable while maintaining the diagnostic capacity of the examination. This review describes a practical approach to the analysis and interpretation of coronary CTA data, including the standardized reporting of the relevant imaging findings to the referring physicians.
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10
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Positive predictive value of computed tomography coronary angiography in clinical practice. Int J Cardiol 2012; 156:315-9. [DOI: 10.1016/j.ijcard.2010.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 10/25/2010] [Accepted: 11/22/2010] [Indexed: 11/17/2022]
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Lekakis J, Abraham P, Balbarini A, Blann A, Boulanger CM, Cockcroft J, Cosentino F, Deanfield J, Gallino A, Ikonomidis I, Kremastinos D, Landmesser U, Protogerou A, Stefanadis C, Tousoulis D, Vassalli G, Vink H, Werner N, Wilkinson I, Vlachopoulos C. Methods for evaluating endothelial function: a position statement from the European Society of Cardiology Working Group on Peripheral Circulation. ACTA ACUST UNITED AC 2012; 18:775-89. [PMID: 21450600 DOI: 10.1177/1741826711398179] [Citation(s) in RCA: 212] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The endothelium holds a pivotal role in cardiovascular health and disease. Assessment of its function was until recently limited to experimental designs due to its location. The advent of novel techniques has facilitated testing on a more detailed basis, with focus on distinct pathways. This review presents available in-vivo and ex-vivo methods for evaluating endothelial function with special focus on more recent ones. The diagnostic modalities covered include assessment of epicardial and microvascular coronary endothelial function, local vasodilation by venous occlusion plethysmography and flow-mediated dilatation, arterial pulse wave analysis and pulse amplitude tonometry, microvascular blood flow by laser Doppler flowmetry, biochemical markers and bioassays, measurement of endothelial-derived microparticles and progenitor cells, and glycocalyx measurements. Insights and practical information on the theoretical basis, methodological aspects, and clinical application in various disease states are discussed. The ability of these methods to detect endothelial dysfunction before overt cardiovascular disease manifests make them attractive clinical tools for prevention and rehabilitation.
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Affiliation(s)
- John Lekakis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Greece
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12
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Kietadisorn R, Juni RP, Moens AL. Tackling endothelial dysfunction by modulating NOS uncoupling: new insights into its pathogenesis and therapeutic possibilities. Am J Physiol Endocrinol Metab 2012; 302:E481-95. [PMID: 22167522 DOI: 10.1152/ajpendo.00540.2011] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Endothelial nitric oxide synthase (eNOS) serves as a critical enzyme in maintaining vascular pressure by producing nitric oxide (NO); hence, it has a crucial role in the regulation of endothelial function. The bioavailability of eNOS-derived NO is crucial for this function and might be affected at multiple levels. Uncoupling of eNOS, with subsequently less NO and more superoxide generation, is one of the major underlying causes of endothelial dysfunction found in atherosclerosis, diabetes, hypertension, cigarette smoking, hyperhomocysteinemia, and ischemia/reperfusion injury. Therefore, modulating eNOS uncoupling by stabilizing eNOS activity, enhancing its substrate, cofactors, and transcription, and reversing uncoupled eNOS are attractive therapeutic approaches to improve endothelial function. This review provides an extensive overview of the important role of eNOS uncoupling in the pathogenesis of endothelial dysfunction and the potential therapeutic interventions to modulate eNOS for tackling endothelial dysfunction.
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Affiliation(s)
- Rinrada Kietadisorn
- Maastricht Univ. Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Weustink AC, de Feyter PJ. The role of multi-slice computed tomography in stable angina management: a current perspective. Neth Heart J 2011; 19:336-43. [PMID: 21792743 PMCID: PMC3144326 DOI: 10.1007/s12471-011-0096-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Contrast-enhanced CT coronary angiography (CTCA) has evolved as a reliable alternative imaging modality technique and may be the preferred initial diagnostic test in patients with stable angina with intermediate pre-test probability of CAD. However, because CTCA is moderately predictive for indicating the functional significance of a lesion, the combination of anatomic and functional imaging will become increasingly important. The technology will continue to improve with better spatial and temporal resolution at low radiation exposure, and CTCA may eventually replace invasive coronary angiography. The establishment of the precise role of CTCA in the diagnosis and management of patients with stable angina requires high-quality randomised study designs with clinical outcomes as a primary outcome.
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Affiliation(s)
- A C Weustink
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Malagò R, Pezzato A, Barbiani C, Mantovani W, Caliari G, Alfonsi U, Tavella D, Mucelli RP. Comparison between different kernel reformatting filters in 3D quantitative analysis of MDCT coronary angiography. Radiol Med 2011; 116:1203-16. [PMID: 21892715 DOI: 10.1007/s11547-011-0719-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 01/26/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Coronary angiography with multidetector-row computed tomography (MDCT-CA) allows quantification of coronary artery stenosis with a high level of accuracy; however, a better estimation of stenosis can be achieved by using appropriate reformatting filters, especially in stents and calcified segments. Quantitative computed tomography angiography (QCTA) is intended to overcome the limitations of the visual score. The aim of this study was to evaluate the accuracy of QCTA with different filters in comparison with quantitative coronary angiography (QCA) and visual score. MATERIALS AND METHODS Two blinded operators visually scored 17 consecutive patients referred for MDCT-CA with a per-segment analysis. The degree of stenosis was classified as 0-20%, 20-50% (wall irregularities), 50-70% (significant disease) and 70-100% (vessel occlusion). Each segment was then analysed using the electronic callipers of the QCTA system with 15 different filters. No contour editing was performed. Data were compared with QCA and conventional coronary angiography (CCA). Comparison between QCTA, visual score and QCA were performed using Spearman's rank correlation. RESULTS Of 25 segments analysed (mean 1.4 diseased segment per patient), 375 measurements were considered. Good correlation was found between the visual score and QCA [Pearson correlation coefficient (rho=0.852; p<0.0001)] and between QCA and CCA (rho=0.804; p<0.0001). Moderate correlation was found between QCA and QCTA only using two filters (rho=0.444; p<0.0001 for YA filter and rho=0.450; p<0.0001 for YB filter). CONCLUSIONS Overall QCTA accuracy is low if contour editing is not applied, especially in calcified vessels. Certain filters can help to better estimate the exact percentage of stenosis.
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Affiliation(s)
- R Malagò
- Department of Radiology, University of Verona, Policlinico GB Rossi, P.le LA Scuro 10, 37134, Verona, Italy.
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CT comparison of visual and computerised quantification of coronary stenosis according to plaque composition. Eur Radiol 2010; 21:712-21. [DOI: 10.1007/s00330-010-1970-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
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Abstract
Recent technological advances have fueled the growth in hybrid radionuclide and CT imaging of the heart. Noninvasive imaging studies are reliable means to diagnose coronary artery disease (CAD), stratify risk, and guide clinical management. Myocardial perfusion scintigraphy is a robust, widely available noninvasive modality for the evaluation of ischemia from known or suspected CAD. Cardiac CT (coronary artery calcium score and coronary CT angiography) has emerged as a clinically robust noninvasive anatomic imaging test, capable of rapidly diagnosing or excluding obstructive CAD. Both anatomic and functional modalities have strengths and weaknesses, and can complement each other by offering integrated structural and physiologic information. As we discuss below, in selected patients, hybrid imaging may facilitate more accurate diagnosis, risk stratification, and management in a "one-stop shop" setting.
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Affiliation(s)
- Edward M. Hsiao
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, and the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bilal Ali
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, and the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sharmila Dorbala
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, and the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Drosch T, Brodoefel H, Reimann A, Thomas C, Tsiflikas I, Heuschmid M, Schroeder S, Burgstahler C. Prevalence and clinical characteristics of symptomatic patients with obstructive coronary artery disease in the absence of coronary calcifications. Acad Radiol 2010; 17:1254-8. [PMID: 20591696 DOI: 10.1016/j.acra.2010.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 05/05/2010] [Accepted: 05/05/2010] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES The quantification of coronary calcification has established itself as a valid risk marker to predict cardiovascular events. However, data derived from cardiac multi-detector row computed tomography could demonstrate that the exclusion of coronary calcification is not synonymous with the exclusion of coronary artery disease (CAD). The aims of this retrospective analysis were to determine the prevalence of significant CAD in a symptomatic cohort with indications for invasive angiography but without coronary calcification (Agatston score 0) as assessed by multislice computed tomography and to investigate whether there were any differences in terms of risk factors between patients with and without significant CAD. MATERIALS AND METHODS Five hundred multislice computed tomographic scans (in 371 men and 129 women) were included in the analysis. Agatston scores were determined on native scans. All patients underwent coronary angiography to detect or rule out obstructive CAD. Patients with negative calcium scoring were selected and divided into two subgroups: those without obstructive CAD and those with obstructive CAD (luminal stenoses > 50%). These subgroups were characterized in terms of clinical characteristics (age and sex) and cardiovascular risk factors (diabetes mellitus, hypertension, hyperlipoproteinemia, familial predisposition, smoking, and overweight). RESULTS Sixty-one of 500 patients (12.2%) had negative calcium scores (Agatston score 0). Sixteen of these patients (26.3%, or 3.2% of the total population) had obstructive CAD according to invasive angiography. Patients with obstructive CAD were significantly older (mean age, 64 ± 9 vs 55 ± 10 years; P = .003) and were more frequently diabetic (25% vs 4%, P = .0389) than patients without obstructive CAD. There were no significant differences with regard to the other risk factors. CONCLUSIONS In this high-risk population, the absence of coronary calcification was not sufficient to rule out CAD. Among patients without coronary calcification, the presence of significant CAD was associated with increased age and the presence of diabetes mellitus.
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Affiliation(s)
- Tanja Drosch
- Medizinische Klinik und Poliklinik III, Medizinische Universitätsklinik Tübingen, D-72076 Tübingen, Germany
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Coronary CT Angiography for the Detection of Obstructive Coronary Artery Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010. [DOI: 10.1007/s12410-010-9045-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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19
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Automated Quantification of Stenosis Severity on 64-Slice CT. JACC Cardiovasc Imaging 2010; 3:699-709. [DOI: 10.1016/j.jcmg.2010.01.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 01/21/2010] [Accepted: 03/01/2010] [Indexed: 11/15/2022]
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Mok MY, Chiu SSH, Lo Y, Mak HKF, Wong WS, Khong PL, Lau CS. Coronary atherosclerosis using computed tomography coronary angiography in patients with systemic sclerosis. Scand J Rheumatol 2010; 38:381-5. [PMID: 19585378 DOI: 10.1080/03009740902992979] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Impaired coronary artery reserve has previously been demonstrated in patients with systemic sclerosis (SSc). Both micro- and macrovascular factors are probably contributory to the underlying pathogenesis. OBJECTIVES To examine the frequency of coronary atherosclerosis in a series of SSc patients by computed tomography coronary angiography (CTCA), a less invasive method than conventional coronary angiography, the current gold standard in the detection of coronary atherosclerosis, and to explore its clinical associations. METHODS Nineteen consecutive SSc patients [six with diffuse (dSSc) and 13 with limited disease (lSSc)] with disease duration of >or= 3 years were recruited. Coronary calcium score and contrast angiography were examined by CT scan. Conventional cardiovascular factors and inflammatory markers were measured and correlated with CT findings. RESULTS The mean+/-SD age of these patients was 52.5+/-12.5 years with median disease duration of 12.5 years. Six (31.6%) patients were found to have coronary artery calcification (calcium score 13-2008). Coronary calcium was detected in one dSSc patient but contrast angiography was not performed because of interference from an in situ implantable cardiac device. Some parts of the coronary arteries were not assessable in two patients who had ectopic cardiac rhythm. Five lSSc patients had calcified plaques causing variable coronary luminal stenosis. All patients were asymptomatic. Patients with abnormal CTCA findings were more likely to be older (p < 0.001) and were less likely to have serum anti-Scl70 antibodies (p = 0.003) than those without, after Bonferroni correction. CONCLUSIONS Coronary atherosclerosis is not uncommon in asymptomatic SSc patients. CTCA is a convenient and non-invasive method for studying coronary atherosclerosis.
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Affiliation(s)
- M Y Mok
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, PR China.
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Abolition of Respiratory-Motion Artifact in Computed Tomography Coronary Angiography with Ultrafast Examinations: A Comparison between 64-row and 320-row Multidetector Scanners. Can Assoc Radiol J 2010; 61:5-12. [DOI: 10.1016/j.carj.2009.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 07/19/2009] [Accepted: 07/20/2009] [Indexed: 11/22/2022] Open
Abstract
Purpose To compare the incidence of respiratory artifact in computed tomography (CT) coronary angiography performed with 64-row and 320-row multidetector scanners and to assess its effect on coronary evaluability. Methods A retrospective review of consecutive coronary angiograms performed on a 64-row multidetector CT from March to April 2007 (group 1: 115 patients, 63 men; mean age [standard deviation] 59.6 ± 12.8 years) and on a 320-row multidetector CT from March to April 2008 (group 2: 169 patients, 89 men; mean [SD] age 57.9 ± 11.6 years). Two cardiac radiologists assessed the occurrence of respiratory artifact and coronary evaluability in studies with respiratory artifacts. Unevaluable coronary segments because of motion at the same anatomical level of the respiratory artifact were considered unevaluable because of this artifact. The association between the occurrence of respiratory artifact and patient biometrics, medication, and scan parameters was examined. Results Respiratory artifacts were detected in 9 of the 115 patients from group 1 (7.8%) and in none of the 169 patients from group 2 ( P < .001). Group 1 had longer scan times (median, 9.3 seconds; range, 7.5−14.4 seconds) compared with group 2 (median, 1.5 seconds; range, 1.1−3.5 seconds; P < .001). In group 1, 4 patients (3.5%) showed unevaluable coronary segments because of respiratory artifacts, and the CT coronary angiography was repeated in 1 patient (0.9%). Conclusions Respiratory artifacts are important in CT coronary angiography performed with 64-row multidetector scanners and impair the diagnostic utility of the examination in up to 3.5% of the studies. These artifacts can be virtually eliminated with a faster scan time provided by 320-row multidetector CT.
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Bastarrika G, Lee YS, Huda W, Ruzsics B, Costello P, Schoepf UJ. CT of coronary artery disease. Radiology 2009; 253:317-38. [PMID: 19864526 DOI: 10.1148/radiol.2532081738] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Technical innovation is rapidly improving the clinical utility of cardiac computed tomography (CT) and will increasingly address current technical limitations, especially the association of this test with relatively high levels of radiation. Guidelines for appropriate indications are in place and are evolving, with an increasing evidence base to ensure the appropriate use of this modality. New technologies and new applications, such as myocardial perfusion imaging and dual-energy CT, are being explored and are widening the scope of coronary CT angiography from mere coronary artery assessment to the integrative analysis of cardiac morphology, function, perfusion, and viability. The scientific evaluation of coronary CT angiography has left the stage of feasibility testing and increasingly, evidence-based data are accumulating on outcomes, prognosis, and cost-effectiveness. In this review, these developments will be discussed in the context of current pivotal transitions in cardiovascular disease management and their potential influence on the current role and future fate of coronary CT angiography will be examined.
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Affiliation(s)
- Gorka Bastarrika
- Department of Radiology and Division of Cardiology, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29401, USA
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Bekkers E, Roos J. Coronary CTA: stenosis classification and quantification, including automated measures. J Cardiovasc Comput Tomogr 2009; 3 Suppl 2:S109-15. [PMID: 20129518 DOI: 10.1016/j.jcct.2009.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 10/23/2009] [Indexed: 11/24/2022]
Abstract
The development of larger multidetector computed tomography (CT) systems has allowed increased accuracy in quantifying obstructive lesions involving the coronary arteries. This article reviews the accuracy of coronary CT angiography (CTA) in quantifying obstructive lesions, evaluating the extent of coronary artery disease, and classifying the composition of coronary plaques. In addition, several outcomes studies and some promising automated techniques for quantifying coronary CTA are reviewed.
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Affiliation(s)
- Erik Bekkers
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Room S-072, Stanford, CA 94305-5105, USA.
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Achenbach S. Stress computed tomography myocardial perfusion: steps, questions, and layers. J Am Coll Cardiol 2009; 54:1085-7. [PMID: 19744617 DOI: 10.1016/j.jacc.2009.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 05/05/2009] [Indexed: 12/01/2022]
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Accuracy of dual-source computed tomography in quantitative assessment of low density coronary stenosis—a motion phantom study. Eur Radiol 2009; 20:542-8. [DOI: 10.1007/s00330-009-1587-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 06/10/2009] [Accepted: 07/15/2009] [Indexed: 10/20/2022]
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Gouya H, Varenne O, Trinquart L, Touzé E, Vignaux O, Spaulding C, Mas JL, Sablayrolles JL. Coronary Artery Stenosis in High-risk Patients: 64–Section CT and Coronary Angiography—Prospective Study and Analysis of Discordance. Radiology 2009; 252:377-85. [DOI: 10.1148/radiol.2522081271] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Dennie CJ, Leipsic J, Brydie A. Canadian Association of Radiologists: Consensus Guidelines and Standards for Cardiac CT. Can Assoc Radiol J 2009; 60:19-34. [DOI: 10.1016/j.carj.2009.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Carole J. Dennie
- Department of Diagnostic Imaging, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
| | - Jonathan Leipsic
- Department of Radiology, Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Alan Brydie
- Department of Radiology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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CT coronary angiography: the continuing challenges of validating and optimizing a new and rapidly developing technique. Int J Cardiovasc Imaging 2008; 24:905-6. [PMID: 18686013 DOI: 10.1007/s10554-008-9348-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
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